Materiały źródłowe

• #1 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3352070/

  Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. […] Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. […] Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. […] Given the high mortality associated with invasive aspergillosis prophylaxis of invasive fungal infections would be ideal. […] Early preemptive treatment with a safe antifungal agent would be an alternative approach, if early diagnosis and effective treatment could reliably be established.

• #2 Treatment and prevention of invasive aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-and-prevention-of-invasive-aspergillosis

  PREVENTION AND EARLY TREATMENT […] – Primary prophylaxis […] – Empiric therapy […] – Pre-emptive therapy […] – Secondary prophylaxis for prevention of relapse […] […] Expert guidelines — Optimal management involves early and definitive diagnosis as well as early initiation of antifungal therapy. In addition to antifungal therapy, surgery should be considered for patients with certain manifestations. Reduction of immunosuppression, when feasible, is another important component of management.

• #3 Exploring Primary Prophylaxis for Invasive Pulmonary Aspergillosis

  https://www.contagionlive.com/view/exploring-primary-prophylaxis-for-invasive-pulmonary-aspergillosis

  Invasive pulmonary aspergillosis affects up to 13% of immunocompromised patients who are in the hospital. […] Primary antifungal prophylaxis is beneficial in preventing the development of invasive pulmonary aspergillosis in certain high-risk patients (ie, those with long-term neutropenia or those with highly immunosuppressive drug regimens or disease states). […] The Infectious Diseases Society of America (IDSA) guideline for the treatment of aspergillosis recommends that patients who have undergone HSCT and now have GVHD or those with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) who are at high risk for invasive pulmonary aspergillosis should receive primary prophylaxis. […] Similarly, the American Society of Clinical Oncology (ASCO) and IDSA guideline for antimicrobial prophylaxis for adult patients with cancer-related immunosuppression recommends primary antifungal prophylaxis targeted at molds for patients with AML or MDS or those undergoing treatment for GVHD.

• #4 Aspergillosis: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14770-aspergillosis

  How can I prevent aspergillosis? It’s hard to avoid Aspergillus molds. If you’re at high risk for infection, talk to your provider about the best ways to protect yourself. Your provider might: […] prescribe an antifungal medicine to prevent infection. […] test you for signs of infection to make sure you get treated early. You might be able to reduce your exposure to fungi by: […] avoiding areas with lots of dust or mold, such as construction sites or compost piles. […] avoiding activities such as gardening or lawn mowing. If you might be exposed to airborne dust or mold, wear an N95 face mask.

• #5 Guideline Recommendations for the Prophylaxis of Invasive Aspergillosis in AML – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/november-2016/guideline-recommendations-for-the-prophylaxis-of-invasive-aspergillosis-in-aml/

  The NCCN and IDSA panels unanimously recommend that patients with acute myeloid leukemia (AML) with neutropenia following induction or reinduction chemotherapy receive antifungal prophylaxis with posaconazole. In the NCCN, it is a category 1 recommendation supported by a significant amount of randomized clinical trial evidence. Like the NCCN guidelines, the IDSA guidelines also strongly recommend posaconazole as the first choice for prophylaxis, citing the same very high-quality data as the NCCN. […] Prophylaxis should be initiated in all patients with AML who (a) develop neutropenia following high-dose induction or reinduction chemotherapy, (b) are neutropenic and/or are receiving immunosuppressive therapy following allogeneic stem cell transplant, and (c) are receiving immunosuppressive therapy for treatment of graft-vs-host disease following allogeneic stem cell transplant. Antifungal prophylaxis should also be considered in patients with AML who develop mucositis after treatment with chemotherapy or an autologous stem cell transplant. Mucositis indicates damage to the gastrointestinal tract that may put these patients at higher risk of developing invasive aspergillosis.

• #6 Management of Invasive Aspergillosis in Acute Myelogenous Leukemia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/july-2016/management-of-invasive-aspergillosis-in-acute-myelogenous-leukemia/

  BM It is challenging to prevent infection. Many of these patients already have colonization of their bodies with the Aspergillus spores before diagnosis of AML. In patients who are not previously colonized, the utilization of rooms with laminar airflow systems may decrease the risk of contamination after the diagnosis. Protective barriers, such as masks, are commonly used to protect these patients to further reduce colonization and infection. The focus, however, is on monitoring for signs and symptoms of infection. […] BM The US Food and Drug Administration approved the azole posaconazole (Noxafil, Merck) for the prophylaxis of invasive Aspergillus in patients at high risk of developing the infection. It is the only therapy approved for prophylaxis. High risk is generally defined as an absolute neutrophil count of 500 cells/mm3 that is expected to persist for 7 days or more following remission-induction chemotherapy for newly diagnosed or relapsed AML.

• #7 Reducing Risk for Aspergillosis | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/prevention/index.html

  It’s difficult to avoid breathing in Aspergillus spores because the fungus is common in the environment. For people who have weakened immune systems, there may be some ways to lower the chances of developing a severe Aspergillus infection. […] It’s important to note that although these actions are recommended, they haven’t been proven to prevent aspergillosis. […] If you are at high risk for developing invasive aspergillosis your healthcare provider may prescribe medication to prevent aspergillosis. […] Some high-risk patients may benefit from blood tests to detect invasive aspergillosis.

• #8 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure (strong recommendation; low-quality evidence). […] These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for IA, such as patients receiving induction/reinduction regimens for acute leukemia (strong recommendation; low-quality evidence). […] In hospitals in which a protected environment is not available, we recommend admission to a private room, no connection to construction sites, and not allowing plants or cut flowers to be brought into the patient’s room (strong recommendation; low-quality evidence). […] We recommend reasonable precautions to reduce mold exposure among outpatients at high risk for IA, including avoidance of gardening, spreading mulch (compost), or close exposure to construction or renovation (strong recommendation; low-quality evidence).

• #9 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure (strong recommendation; low-quality evidence). […] These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for IA, such as patients receiving induction/reinduction regimens for acute leukemia (strong recommendation; low-quality evidence). […] In hospitals in which a protected environment is not available, we recommend admission to a private room, no connection to construction sites, and not allowing plants or cut flowers to be brought into the patient’s room (strong recommendation; low-quality evidence). […] We recommend reasonable precautions to reduce mold exposure among outpatients at high risk for IA, including avoidance of gardening, spreading mulch (compost), or close exposure to construction or renovation (strong recommendation; low-quality evidence).

• #10

  https://haematologica.org/article/view/5639

  Current guidelines recommend several preventive measures that aim to decrease the rate of IA by reducing exposure of neutropenic patients to Aspergillus spores. Well-documented measures include HEPA filtration and positive air pressure rooms in high-risk units, cleaning of surfaces in patients rooms, regular environmental surveillance, and wearing of high-efficiency masks by neutropenic patients. […] Thus, our results suggest that primary IA prophylaxis with well-tolerated antifungal agents such as voriconazole could be of benefit in reducing the incidence of IA in hematology units exposed to construction/renovation work. […] This retrospective study suggests that antifungal prophylaxis with new agents such as voriconazole is safe and could be of interest in order to reduce the incidence of IA in hematology units exposed to recurrent building work/renovation.

• #11 Aspergillosis

  https://www.nhs.uk/conditions/aspergillosis/

  It’s almost impossible to completely avoid aspergillus mould. […] But there are things you can do to lower your chances of getting aspergillosis if you have a lung condition or weakened immune system. […] try to avoid places where aspergillus mould is often found, such as compost heaps and piles of dead leaves […] open your windows several times a day to air your rooms, especially if you’re cooking or using a shower […] wear a face mask in dusty places or when you’re gardening […] consider using a dehumidifier and an air purifier with a HEPA filter at home […] keep your house heated at between 18 and 21C in cold weather […] do not dry your laundry in your bedroom or living areas, if possible ideally dry it outside or in a tumble dryer […] do not open your windows if there’s construction work or digging outside.

• #12 Aspergillosis: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14770-aspergillosis

  How can I prevent aspergillosis? It’s hard to avoid Aspergillus molds. If you’re at high risk for infection, talk to your provider about the best ways to protect yourself. Your provider might: […] prescribe an antifungal medicine to prevent infection. […] test you for signs of infection to make sure you get treated early. You might be able to reduce your exposure to fungi by: […] avoiding areas with lots of dust or mold, such as construction sites or compost piles. […] avoiding activities such as gardening or lawn mowing. If you might be exposed to airborne dust or mold, wear an N95 face mask.

• #13 Aspergillus Fumigatus: Types, Conditions, Symptoms, and More

  https://www.healthline.com/health/aspergillus-fumigatus

  A. fumigatus and other Aspergillus species are present throughout the environment. For this reason, it can be difficult to prevent exposure. However, if you’re in an at-risk group, there are some steps that you can take to make infection less likely. […] Avoid activities that are more likely to bring you into contact with Aspergillus species. Examples include gardening, yard work, or visiting construction sites. If you must be in these environments, be sure to wear long pants and sleeves. Wear gloves if you’ll be handling soil or manure. An N95 respirator may help if you’re going to be exposed to very dusty areas. […] If you’ve recently undergone a procedure like an organ transplant, your doctor may prescribe antifungal medications to prevent infection. […] If you’re in an at-risk group, periodic testing for Aspergillus may help to detect an infection in its early stages. If an infection is detected, you and your doctor can work together to develop a treatment plan.

• #14 What Is Aspergillosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/aspergillus/

  The type of mold that causes most forms of aspergillosis, Aspergillus fumigatus, is common in our environment. Fortunately, everyday exposure is rarely a problem for people with healthy immune systems. When mold spores are inhaled by a healthy individual, the immune system surrounds and destroys them. […] People with weakened immune systems, who are at a greater risk of infection, can take a few steps to help prevent illness: […] Avoid construction or excavation sites, where dust is heavy. Wear an N95 mask if you cant limit your exposure to these areas. […] Avoid activities that include close contact with soil or dust, such as yard work or gardening. If you do these activities, especially if you handle soil, moss, or manure, wear shoes, long pants, and a long-sleeved shirt. […] Clean any cuts or skin abrasions well with soap and water, especially if theyve been exposed to soil or dust.

• #15 Aspergillosis Guidelines: Guidelines Summary, Infectious Diseases Society of America (IDSA), European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology, and the European Respiratory Society (ESCMID-E

  https://emedicine.medscape.com/article/296052-guidelines

  Prophylactic regimens with posaconazole, voriconazole, and/or micafungin are considered to be most effective. […] Recommend prophylaxis with posaconazole, voriconazole, and/or micafungin during prolonged neutropenia for those who are at high risk for invasive aspergillosis. […] Primary prophylaxis with posaconazole strongly recommended in patients with acute myelogenous leukemia or myelodysplastic syndrome receiving induction chemotherapy. […] Secondary prophylaxis strongly recommended in high-risk patients.

• #16 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Leukemia and transplant centers should perform regular surveillance of cases of invasive mold infection. An increase in incidence over baseline or the occurrence of invasive mold infections in patients who are not at high risk for such infections should prompt evaluation for a hospital source (strong recommendation; low-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence). Prophylaxis with caspofungin is also probably effective (weak recommendation; low-quality evidence). Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability (strong recommendation; moderate-quality evidence).

• #17 Exploring Primary Prophylaxis for Invasive Pulmonary Aspergillosis

  https://www.contagionlive.com/view/exploring-primary-prophylaxis-for-invasive-pulmonary-aspergillosis

  IDSA, ASCO, and National Comprehensive Cancer Network (NCCN) guidelines recommend aspergillosis prophylaxis in patients undergoing intensive chemotherapy for AML, MDS or where the expected period of neutropenia is anticipated to be at least 2 weeks. […] Prophylaxis should be given to patients with GVHD receiving chronic immunosuppression (corticosteroid equivalent more than 1 mg/kg/day of prednisone for more than 2 weeks or another anti-GVHD therapy) until immunosuppression is no longer necessary. […] Patients who’ve undergone a lung transplant benefit from prophylaxis during the first 3 to 4 months post transplant. […] Long-term prophylaxis with posaconazole or voriconazole can be a significant financial burden to patients. […] NCCN and IDSA guidelines explicitly recommend anti-mold active agents in the prophylaxis of aspergillosis.

• #18 Guideline Recommendations for the Prophylaxis of Invasive Aspergillosis in AML – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/november-2016/guideline-recommendations-for-the-prophylaxis-of-invasive-aspergillosis-in-aml/

  The NCCN and IDSA panels unanimously recommend that patients with acute myeloid leukemia (AML) with neutropenia following induction or reinduction chemotherapy receive antifungal prophylaxis with posaconazole. In the NCCN, it is a category 1 recommendation supported by a significant amount of randomized clinical trial evidence. Like the NCCN guidelines, the IDSA guidelines also strongly recommend posaconazole as the first choice for prophylaxis, citing the same very high-quality data as the NCCN. […] Prophylaxis should be initiated in all patients with AML who (a) develop neutropenia following high-dose induction or reinduction chemotherapy, (b) are neutropenic and/or are receiving immunosuppressive therapy following allogeneic stem cell transplant, and (c) are receiving immunosuppressive therapy for treatment of graft-vs-host disease following allogeneic stem cell transplant. Antifungal prophylaxis should also be considered in patients with AML who develop mucositis after treatment with chemotherapy or an autologous stem cell transplant. Mucositis indicates damage to the gastrointestinal tract that may put these patients at higher risk of developing invasive aspergillosis.

• #19 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-16-4-145

  Both posaconazole trials proved to be effective in the reduction of invasive fungal infections in particular against aspergillosis. […] Echinocandins inhibit the synthesis of 1,3–D-glucan, an essential component of the fungal cell wall. […] With the introduction of these new and safer antifungals with a proven efficacy against aspergillosis prophylaxis has become a major issue and reasonable field for clinical investigation. […] Infectious disease guidelines recommend prophylaxis against aspergillosis on data of randomized controlled trials. […] Posaconazole 600 mg/d is strongly recommended in patients with acute myelogenous leukemia/myelodysplastic syndromes or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality of invasive aspergillosis (Level A I).

• #20 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #21 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend prophylaxis with posaconazole for allogeneic HSCT recipients with GVHD who are at high risk for IA (strong recommendation; high-quality evidence). Prophylaxis with other mold-active azoles is also effective. Voriconazole is commonly used for prophylaxis against IA in high-risk patients but did not show improved survival in clinical trials (strong recommendation; moderate-quality evidence). Prophylaxis with itraconazole is limited by tolerability and absorption (strong recommendation; high-quality evidence). […] We recommend antifungal prophylaxis with either a systemic triazole such as voriconazole or itraconazole or an inhaled AmB product for 3 to 4 months after lung transplant (strong recommendation; moderate-quality evidence). […] We recommend that both surgery and either systemic voriconazole or a lipid formulation of AmB be used in invasive Aspergillus fungal sinusitis but that surgical removal alone can be used to treat Aspergillus fungal ball of the paranasal sinus. Enlargement of the sinus ostomy may be needed to improve drainage and prevent recurrence (strong recommendation; moderate-quality evidence).

• #22

  https://link.springer.com/article/10.1007/s40506-020-00213-w

  To discuss the approach to antifungal prophylaxis and treatment for invasive aspergillosis in immunocompromised patients with hematologic malignancies, hematopoietic stem cell transplant, and solid organ transplant recipients. […] Primary prophylaxis against Aspergillus is recommended for patients with acute myelogenous leukemia receiving remission-induction chemotherapy. Posaconazole or voriconazole are appropriate antifungal agents. A new formulation of itraconazole (SUBA-itraconazole) is an alternative option. […] For liver transplant recipients, targeted prophylaxis is recommended in the presence of certain risk factors. […] Reduction in immunosuppression is recommended as part of the management of invasive aspergillosis. […] The approach to prevention and treatment of invasive aspergillosis has evolved along with changes in immunosuppressive treatment and introduction of novel antifungal agents.

• #23 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3352070/

  Targeted prophylaxis against aspergillosis is therefore a need and can not be covered by fluconazole. […] Two randomized controlled trials evaluated the prophylactic use of posaconazole in acute leukemia and in the allogeneic hematopoietic stem cell transplant (HSCT) setting. […] Both posaconazole trials proved to be effective in the reduction of invasive fungal infections in particular against aspergillosis. […] There is moderate evidence of voriconazole for prophylaxis of invasive fungal infections measured and compared eighty days after end of prophylaxis. […] Physicians are now headed with the management of suspected fungal infections in febrile neutropenic patients undergoing posaconazole prophylaxis. […] A posaconazole trough threshold of 0.5 g/ml has been proposed for optimized antifungal prevention.

• #24 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis

  There is no vaccine for aspergillosis. Prophylaxis is crucial for at-risk patients such as bone marrow transplant recipients, for whom posaconazole is used as a first-line treatment.

• #25 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend prophylaxis with posaconazole for allogeneic HSCT recipients with GVHD who are at high risk for IA (strong recommendation; high-quality evidence). Prophylaxis with other mold-active azoles is also effective. Voriconazole is commonly used for prophylaxis against IA in high-risk patients but did not show improved survival in clinical trials (strong recommendation; moderate-quality evidence). Prophylaxis with itraconazole is limited by tolerability and absorption (strong recommendation; high-quality evidence). […] We recommend antifungal prophylaxis with either a systemic triazole such as voriconazole or itraconazole or an inhaled AmB product for 3 to 4 months after lung transplant (strong recommendation; moderate-quality evidence). […] We recommend that both surgery and either systemic voriconazole or a lipid formulation of AmB be used in invasive Aspergillus fungal sinusitis but that surgical removal alone can be used to treat Aspergillus fungal ball of the paranasal sinus. Enlargement of the sinus ostomy may be needed to improve drainage and prevent recurrence (strong recommendation; moderate-quality evidence).

• #26 Managing aspergillosis: updated guidelines from IDSA – Clinical Advisor

  https://www.clinicaladvisor.com/news/managing-aspergillosis-updated-guidelines-from-idsa/2/

  Patients who are at high risk for IA should undergo prophylaxis with posaconazole, voriconazole, and/or micafungin during prolonged neutropenia. […] For lung transplant patients, antifungal prophylaxis should include either a systemic triazole or an inhaled AmB product for 3 to 4 months after lung transplant. […] For non-lung solid organ transplant patients, prophylactic strategies should be based on the institutional epidemiology of infection and assessment of individual risk factors.

• #27 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-16-4-145

  Aerosolized liposomal amphotericin B is recommended during prolonged neutropenia (Level B II). […] There is moderate evidence of voriconazole for prophylaxis of invasive fungal infections measured and compared eighty days after end of prophylaxis. […] Antifungal prophylaxis will remain a standard approach in patients at high risk for invasive fungal infections while meticulous clinical judgement and treatment of febrile neutropenic episodes remain necessary.

• #28

  https://link.springer.com/article/10.1007/s40506-020-00213-w

  To discuss the approach to antifungal prophylaxis and treatment for invasive aspergillosis in immunocompromised patients with hematologic malignancies, hematopoietic stem cell transplant, and solid organ transplant recipients. […] Primary prophylaxis against Aspergillus is recommended for patients with acute myelogenous leukemia receiving remission-induction chemotherapy. Posaconazole or voriconazole are appropriate antifungal agents. A new formulation of itraconazole (SUBA-itraconazole) is an alternative option. […] For liver transplant recipients, targeted prophylaxis is recommended in the presence of certain risk factors. […] Reduction in immunosuppression is recommended as part of the management of invasive aspergillosis. […] The approach to prevention and treatment of invasive aspergillosis has evolved along with changes in immunosuppressive treatment and introduction of novel antifungal agents.

• #29 Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05958-3

  Considering the devastating consequences of IA in SOT recipients, mold-active primary prophylaxis is used routinely in some transplant centers. […] However, the administration of broad-spectrum antifungal prophylaxis in the SOT setting remains controversial, considering the lack of available evidence, significant drug-drug interactions (particularly between azoles and some immunosuppressive agents), costs, selection for resistant pathogens (in particular, Candida spp.) and the risk of breakthrough IMI caused by resistant molds. […] A recent prospective randomized clinical trial for antifungal prophylaxis of liver transplant recipients based on prior identified risk factors for IA failed to show significant benefit, at least partly due to the low number of patients diagnosed with IA. […] The use of aerosolized amphotericin B lipid complex as a standard mold-active prophylaxis appeared to be beneficial when used for up to 18 days after surgery.

• #30 Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis

  https://www.mdpi.com/2079-6382/11/12/1704

  The COVID-19 pandemic has redemonstrated the importance of the fungal-after-viral phenomenon, and the question of whether prophylaxis should be used to prevent COVID-19-associated pulmonary aspergillosis (CAPA). […] There are only six studies that have investigated antifungal prophylaxis for CAPA. […] Randomized controlled trials are needed to better understand the role of antifungal prophylaxis. […] As of the writing of this review, there are no antifungal medications that are listed as clinically indicated for prophylaxis for patients in the ICU. […] Previous studies suggested that antifungal prophylaxis was beneficial only when baseline rates of invasive fungal infections were greater than 15% to 30%. […] Regarding CAPA prophylaxis specifically, there are no randomized controlled trials to date.

• #31 Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis

  https://www.mdpi.com/2079-6382/11/12/1704

  There have been a total of six publications that specifically comment on antifungal prophylaxis for CAPA. […] Antifungal prophylaxis can reduce the incidence of CAPA among mechanically ventilated patients with severe COVID-19. […] However, the clinical significance of the limited data needs to be explored. […] Randomized controlled trials are needed to guide clinical decisions. […] If institutions are electing to use antifungal prophylaxis for CAPA, it is important to consider the agent of choice for prophylaxis, the monitoring of that agent, and the timeline of prophylaxis. […] We argue that although the classic hospitalizations of COVID-19 patients may be changing, the fungal-after-viral phenomenon will become even more relevant to certain patient populations, most specifically, the immunocompromised patient population. […] Until then, the decision to use antifungal prophylaxis lies in the hands of individual institutions, considering the above information.

• #32 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3352070/

  Therapeutic drug monitoring of posaconazole is mandatory in immunosuppressed patients, at least in those with gastrointestinal disorders and the administration of proton pump inhibitors. […] For patients developing new lung infiltrates or symptoms of acute rhinosinusitis while being on posaconazole for IFI prophylaxis a switch to other licensed antifungals should be considered. […] Antifungal prophylaxis will remain a standard approach in patients at high risk for invasive fungal infections while meticulous clinical judgement and treatment of febrile neutropenic episodes remain necessary.

• #33 Guideline Recommendations for the Prophylaxis of Invasive Aspergillosis in AML – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/november-2016/guideline-recommendations-for-the-prophylaxis-of-invasive-aspergillosis-in-aml/

  In our facility, we routinely use antifungal agents for mold prophylaxis in high-risk patients with AML. In some cases, we also closely monitor drug levels in patients with AML who are receiving long-term prophylaxis with posaconazole, voriconazole, or fluconazole. Because individuals may metabolize azole drugs differently, monitoring drug levels can help to ensure that the azoles achieve sufficient therapeutic levels to effectively prevent invasive aspergillosis.

• #34 Exploring Primary Prophylaxis for Invasive Pulmonary Aspergillosis

  https://www.contagionlive.com/view/exploring-primary-prophylaxis-for-invasive-pulmonary-aspergillosis

  IDSA, ASCO, and National Comprehensive Cancer Network (NCCN) guidelines recommend aspergillosis prophylaxis in patients undergoing intensive chemotherapy for AML, MDS or where the expected period of neutropenia is anticipated to be at least 2 weeks. […] Prophylaxis should be given to patients with GVHD receiving chronic immunosuppression (corticosteroid equivalent more than 1 mg/kg/day of prednisone for more than 2 weeks or another anti-GVHD therapy) until immunosuppression is no longer necessary. […] Patients who’ve undergone a lung transplant benefit from prophylaxis during the first 3 to 4 months post transplant. […] Long-term prophylaxis with posaconazole or voriconazole can be a significant financial burden to patients. […] NCCN and IDSA guidelines explicitly recommend anti-mold active agents in the prophylaxis of aspergillosis.

• #35 Outcome Analysis of Breakthrough Invasive Aspergillosis on Anti-Mold Azole Prophylaxis and Treatment: 30-Year Experience in Hematologic Malignancy Patients

  https://www.mdpi.com/2309-608X/11/2/160

  Patients who develop breakthrough IA while receiving anti-mold azole prophylaxis show a worse prognosis than those receiving fluconazole or no prophylaxis, possibly due to the emergence of azole resistance with the wide use of anti-mold azole prophylaxis. […] The Infectious Diseases Society of America (IDSA) issued updated guidelines in 2016 recommending azoles as the primary prophylactic agents for IA in high-risk cancer patients, based on evidence from pivotal clinical trials. […] Despite effective prophylaxis, breakthrough IA infections can occur, often due to drug resistance or inadequate therapeutic drug levels. […] The IDSA guidelines emphasize the importance of therapeutic drug monitoring to optimize antifungal levels and suggest switching to alternative agents such as liposomal amphotericin B (AMB) or echinocandins in cases of breakthrough infection due to factors such as azole resistance and suboptimal therapeutic levels.

• #36 Prevention of Invasive Aspergillosis in High-Risk Patients: Universal Versus Preemptive, Targeted Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5614449/

  Invasive aspergillosis (IA) is associated with increased morbidity and mortality, and there is a need for better preventative and therapeutic approaches. […] Prophylaxis and empirical therapy for high-risk patients have been popular for decades, and now a preemptive, targeted approach to IA management has become more attractive. […] Prophylaxis is defined as administration of an antifungal agent in order to prevent fungal infection in a patient who is at risk for the infection but shows no signs or symptoms of active disease. […] With the high mortality associated with IA and difficulty of diagnosis, prophylaxis seems like a logical strategy in high-risk patients. […] Important consequences of prophylaxis include toxicities, drug interactions, breakthrough infections, selection or development of resistant organisms, and potential limitations in future antifungal therapy if a fungal infection is documented.

• #37 Prevention of Invasive Aspergillosis in High-Risk Patients: Universal Versus Preemptive, Targeted Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5614449/

  Given the limitations of universal prophylaxis and empirical therapy, an alternative management strategy is the use of preemptive, targeted therapy. […] Preemptive, targeted therapy is becoming more attractive and feasible in the past decade with the availability of better diagnostic studies and imaging techniques and the belief that earlier detection of infection will lead to improved outcomes. […] It is imperative to better identify the patient at high risk for IA and the periods of high risk, which would improve the predictive value of diagnostic testing and potentially limit overtreatment with antifungal therapy. […] Although these studies have demonstrated interesting results, especially reduction of inappropriate antifungal use, earlier detection of disease, and identification of IFI that would not have been suspected due to lack of fever, these trials were preliminary and do not allow for comparative outcome data. […] Each strategy has benefits and limitations, but important considerations include incidence of IA in the population, drug toxicities and costs, overtreatment of patients, and selection of drug resistance.

• #38 Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05958-3

  A preemptive therapy is currently recommended only in lung transplant recipients, while a targeted prophylaxis is favored in liver and heart transplant recipients. […] Overall, most existing data on prophylaxis and preemptive therapy of IA are based on retrospective cohort and case-control studies.

• #39

  https://link.springer.com/article/10.1007/s12281-010-0007-9

  Difficulty in making an early diagnosis of invasive aspergillosis and consequent poor clinical outcome have led to prophylactic and preemptive management strategies in patients at high risk. […] Prophylactic mode involves antifungal administration throughout the at risk period to prevent infection; published studies with posaconazole and to a much lesser extent, itraconazole, are of promise. […] At present, prophylaxis against invasive aspergillosis with mold-active azoles may be reserved for those at the highest risk; for those at intermediate risk, prophylaxis with a yeast-active drug combined with the preemptive screening strategy is prudent.

• #40 Aspergillosis Guidelines: Guidelines Summary, Infectious Diseases Society of America (IDSA), European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology, and the European Respiratory Society (ESCMID-E

  https://emedicine.medscape.com/article/296052-guidelines

  Prophylactic regimens with posaconazole, voriconazole, and/or micafungin are considered to be most effective. […] Recommend prophylaxis with posaconazole, voriconazole, and/or micafungin during prolonged neutropenia for those who are at high risk for invasive aspergillosis. […] Primary prophylaxis with posaconazole strongly recommended in patients with acute myelogenous leukemia or myelodysplastic syndrome receiving induction chemotherapy. […] Secondary prophylaxis strongly recommended in high-risk patients.

• #41 Management of Invasive Aspergillosis in Acute Myelogenous Leukemia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/july-2016/management-of-invasive-aspergillosis-in-acute-myelogenous-leukemia/

  It is critical to continue treatment as secondary prophylaxis for as long as the patient remains neutropenic or immunocompromised. Most guidelines state that subsequent treatment, often called secondary prophylaxis, should be used in patients who continue to receive therapy and are expected to experience further periods of neutropenia or immunosuppression. Those patients should receive therapy until they complete their chemotherapy regimens or until they complete immunosuppressive therapy after a bone marrow transplant.

• #42 Management of Invasive Aspergillosis in Acute Myelogenous Leukemia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/july-2016/management-of-invasive-aspergillosis-in-acute-myelogenous-leukemia/

  It is critical to continue treatment as secondary prophylaxis for as long as the patient remains neutropenic or immunocompromised. Most guidelines state that subsequent treatment, often called secondary prophylaxis, should be used in patients who continue to receive therapy and are expected to experience further periods of neutropenia or immunosuppression. Those patients should receive therapy until they complete their chemotherapy regimens or until they complete immunosuppressive therapy after a bone marrow transplant.

• #43

  https://haematologica.org/article/view/5639

  Invasive aspergillosis is a common life-threatening infection in patients with acute leukemia. The presence of building work near to hospital wards in which these patients are cared for is an important risk factor for the development of invasive aspergillosis. This study assessed the impact of voriconazole or caspofungin prophylaxis in patients undergoing induction chemotherapy for acute leukemia in a hematology unit exposed to building work. […] This study suggests that antifungal prophylaxis with voriconazole could be useful in acute leukemia patients undergoing first remission-induction chemotherapy in settings in which there is a high-risk of invasive aspergillosis. […] The aim of this study was to assess the impact of primary prophylaxis with voriconazole or caspofungin in acute leukemia patients undergoing intensive chemotherapy for remission-induction in a conventional unit without laminar air flow during a period of construction work.

• #44 Factsheet – Health Protection Surveillance Centre

  https://www.hpsc.ie/a-z/respiratory/aspergillosis/factsheet/

  Aspergillus is an environmental mould fungus that survives in soil and dust. Disturbance of these during hospital building, renovation or demolition work can generate airborne spores of the fungus which if inhaled by susceptible patients can lead to an often fatal lung infection called invasive aspergillosis. […] A risk assessment will help to devise a combination of measures that may include environmental dust control and cleaning, prevention of ingress of airborne spores from outside clinical areas, protective environments for highest risk patients, and antifungal drug prophylaxis. […] HEPA-filtered positive pressure isolation rooms are the only type of protective environment for which there is a scientific evidence base. […] Published international guidelines show that the evidence for effective prevention of Aspergillus infection is limited to patients with haematological malignancies and those undergoing haematopoietic stem cell transplantation. The triazole Posaconazole has the strongest grade of recommendation in these groups.

• #45

  https://commercialairfiltration.co.uk/pages/invasive-aspergillosis-prevention?srsltid=AfmBOorLo5XhF48mHg1wVa9tUnmtNBtHlv9Z-P4ownysTrfbtkEJhPVz

  Aspergillus mould is ubiquitous in the fabric of healthcare buildings which makes it difficult to avoid invasive aspergillosis infection for patients with a weakened immune system. […] In order to protect patients, Commercial Air Filtration works with Infection Control Teams and Facilities Managers to specify the optimum mobile air filtration solution to help control the potential airborne hazard of aspergillus. […] Mobile air purification systems are an effective enhancement to existing ventilation systems. […] Clinical trials on the effectiveness of the IQAir mobile air filtration systems in the clinical setting show a reduction of invasive aspergillosis infection by over 50%. […] Providing filtered air for patients with weakened immunity in environments with potential for invasive aspergillosis infections can be an effective safeguard.

• #46

  https://commercialairfiltration.co.uk/pages/invasive-aspergillosis-prevention?srsltid=AfmBOorLo5XhF48mHg1wVa9tUnmtNBtHlv9Z-P4ownysTrfbtkEJhPVz

  Installation of a mobile unit in each specific area will ensure no mould spores can be inhaled. […] This is a simple and easily achieved solution. […] The IQAir high-performance units are capable of capturing and retaining among other things the 38 species of Aspergillus spores which cause the disease with a near perfect filtration efficiency. […] Maintaining indoor air quality (IAQ) during any renovation works is achieved by the use of mobile air filtration units, a key element of invasive aspergillosis prevention. […] The highly effective, inexpensive and easily deployed solution against invasive aspergillosis infection from Commercial Air Filtration is to create a locally controlled environment for each individual room in a transplant unit with susceptive patients. […] Mobile IQAir units can be deployed directly at each critical location to capture and retain bacteria, viruses and mould spores, as well as bioaerosols without any need for building, works.

• #47 Prevention of Invasive Aspergillosis in High-Risk Patients: Universal Versus Preemptive, Targeted Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5614449/

  Invasive aspergillosis (IA) is associated with increased morbidity and mortality, and there is a need for better preventative and therapeutic approaches. […] Prophylaxis and empirical therapy for high-risk patients have been popular for decades, and now a preemptive, targeted approach to IA management has become more attractive. […] Prophylaxis is defined as administration of an antifungal agent in order to prevent fungal infection in a patient who is at risk for the infection but shows no signs or symptoms of active disease. […] With the high mortality associated with IA and difficulty of diagnosis, prophylaxis seems like a logical strategy in high-risk patients. […] Important consequences of prophylaxis include toxicities, drug interactions, breakthrough infections, selection or development of resistant organisms, and potential limitations in future antifungal therapy if a fungal infection is documented.

• #48 Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05958-3

  Considering the devastating consequences of IA in SOT recipients, mold-active primary prophylaxis is used routinely in some transplant centers. […] However, the administration of broad-spectrum antifungal prophylaxis in the SOT setting remains controversial, considering the lack of available evidence, significant drug-drug interactions (particularly between azoles and some immunosuppressive agents), costs, selection for resistant pathogens (in particular, Candida spp.) and the risk of breakthrough IMI caused by resistant molds. […] A recent prospective randomized clinical trial for antifungal prophylaxis of liver transplant recipients based on prior identified risk factors for IA failed to show significant benefit, at least partly due to the low number of patients diagnosed with IA. […] The use of aerosolized amphotericin B lipid complex as a standard mold-active prophylaxis appeared to be beneficial when used for up to 18 days after surgery.

• #49 Exploring Primary Prophylaxis for Invasive Pulmonary Aspergillosis

  https://www.contagionlive.com/view/exploring-primary-prophylaxis-for-invasive-pulmonary-aspergillosis

  IDSA, ASCO, and National Comprehensive Cancer Network (NCCN) guidelines recommend aspergillosis prophylaxis in patients undergoing intensive chemotherapy for AML, MDS or where the expected period of neutropenia is anticipated to be at least 2 weeks. […] Prophylaxis should be given to patients with GVHD receiving chronic immunosuppression (corticosteroid equivalent more than 1 mg/kg/day of prednisone for more than 2 weeks or another anti-GVHD therapy) until immunosuppression is no longer necessary. […] Patients who’ve undergone a lung transplant benefit from prophylaxis during the first 3 to 4 months post transplant. […] Long-term prophylaxis with posaconazole or voriconazole can be a significant financial burden to patients. […] NCCN and IDSA guidelines explicitly recommend anti-mold active agents in the prophylaxis of aspergillosis.

• #50 TREATMENT OF ASPERGILLOSIS – Mycology Advocacy, Research & Education (MyCARE)

  https://fightfungus.org/treatment-of-aspergillosis/

  Careful consideration of prophylaxis. Prophylaxis practices vary from provider to provider and from institution to institution. Most providers are careful to only use antifungal prophylaxis in patients who are at very high risk for invasive aspergillosis. Other providers do not use prophylaxis at all for their high-risk patients. Why be so careful with prophylaxis? Reasons include cost of therapy, side effects, the interactions with other drugs, and the problem of antifungal resistance. […] Prophylaxis is an action taken to prevent a disease. For some patients who are immunocompromised, antifungals can be used as prophylaxis in an attempt to prevent the development of fungal disease.

• #51 Outcome Analysis of Breakthrough Invasive Aspergillosis on Anti-Mold Azole Prophylaxis and Treatment: 30-Year Experience in Hematologic Malignancy Patients

  https://www.mdpi.com/2309-608X/11/2/160

  However, when breakthrough infections on prophylaxis or azole resistance occur in high-risk patients, the IDSA guidelines recommend switching to alternative agents like liposomal AMB or echinocandins for primary treatment, although these options come with limitations, such as higher toxicity and reduced efficacy, compared to azoles. […] The overuse of azoles as IA prophylaxis in immunocompromised patients may be contributing to the rise in resistance and may lead to worse clinical outcomes in immunocompromised patients with breakthrough IA. […] Future studies should evaluate azole resistance in patients who end up with breakthrough IA and what would be the optimal therapeutic option while considering the possibility of combination therapy.

• #52 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Leukemia and transplant centers should perform regular surveillance of cases of invasive mold infection. An increase in incidence over baseline or the occurrence of invasive mold infections in patients who are not at high risk for such infections should prompt evaluation for a hospital source (strong recommendation; low-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence). Prophylaxis with caspofungin is also probably effective (weak recommendation; low-quality evidence). Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability (strong recommendation; moderate-quality evidence).

• #53 Prevention of Invasive Aspergillosis in High-Risk Patients: Universal Versus Preemptive, Targeted Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5614449/

  Given the limitations of universal prophylaxis and empirical therapy, an alternative management strategy is the use of preemptive, targeted therapy. […] Preemptive, targeted therapy is becoming more attractive and feasible in the past decade with the availability of better diagnostic studies and imaging techniques and the belief that earlier detection of infection will lead to improved outcomes. […] It is imperative to better identify the patient at high risk for IA and the periods of high risk, which would improve the predictive value of diagnostic testing and potentially limit overtreatment with antifungal therapy. […] Although these studies have demonstrated interesting results, especially reduction of inappropriate antifungal use, earlier detection of disease, and identification of IFI that would not have been suspected due to lack of fever, these trials were preliminary and do not allow for comparative outcome data. […] Each strategy has benefits and limitations, but important considerations include incidence of IA in the population, drug toxicities and costs, overtreatment of patients, and selection of drug resistance.

• #54 Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis

  https://www.mdpi.com/2079-6382/11/12/1704

  There have been a total of six publications that specifically comment on antifungal prophylaxis for CAPA. […] Antifungal prophylaxis can reduce the incidence of CAPA among mechanically ventilated patients with severe COVID-19. […] However, the clinical significance of the limited data needs to be explored. […] Randomized controlled trials are needed to guide clinical decisions. […] If institutions are electing to use antifungal prophylaxis for CAPA, it is important to consider the agent of choice for prophylaxis, the monitoring of that agent, and the timeline of prophylaxis. […] We argue that although the classic hospitalizations of COVID-19 patients may be changing, the fungal-after-viral phenomenon will become even more relevant to certain patient populations, most specifically, the immunocompromised patient population. […] Until then, the decision to use antifungal prophylaxis lies in the hands of individual institutions, considering the above information.

• #55

  https://link.springer.com/article/10.1007/s40506-020-00213-w

  This meta-analysis showed that mold-active prophylaxis significantly reduced the rate of invasive aspergillosis compared to fluconazole in cancer patients receiving chemotherapy or hematopoietic stem cell transplant. […] In this retrospective study, targeted antifungal prophylaxis in liver transplant recipients effectively prevented invasive fungal infections and reduced the number of patients exposed to antifungals. […] In this trial, liposomal amphotericin B 5 mg/kg twice weekly was not effective as prophylaxis against invasive fungal infections in patients with acute lymphoblastic leukemia. […] This is a recent report of breakthrough invasive fungal infections in 145 patients with hematologic malignancies and hematopoietic stem cell transplant recipients receiving primary prophylaxis with isavuconazole. The role of isavuconazole as primary prophylaxis has yet to be defined. […] In this review article, the evidence on immune modulating therapy for the management of invasive mold disease is summarized.

• #56 Outcome Analysis of Breakthrough Invasive Aspergillosis on Anti-Mold Azole Prophylaxis and Treatment: 30-Year Experience in Hematologic Malignancy Patients

  https://www.mdpi.com/2309-608X/11/2/160

  However, when breakthrough infections on prophylaxis or azole resistance occur in high-risk patients, the IDSA guidelines recommend switching to alternative agents like liposomal AMB or echinocandins for primary treatment, although these options come with limitations, such as higher toxicity and reduced efficacy, compared to azoles. […] The overuse of azoles as IA prophylaxis in immunocompromised patients may be contributing to the rise in resistance and may lead to worse clinical outcomes in immunocompromised patients with breakthrough IA. […] Future studies should evaluate azole resistance in patients who end up with breakthrough IA and what would be the optimal therapeutic option while considering the possibility of combination therapy.

• #57 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis

  There is no vaccine for aspergillosis. Prophylaxis is crucial for at-risk patients such as bone marrow transplant recipients, for whom posaconazole is used as a first-line treatment.

• #58 Reducing Risk for Aspergillosis | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/prevention/index.html

  It’s difficult to avoid breathing in Aspergillus spores because the fungus is common in the environment. For people who have weakened immune systems, there may be some ways to lower the chances of developing a severe Aspergillus infection. […] It’s important to note that although these actions are recommended, they haven’t been proven to prevent aspergillosis. […] If you are at high risk for developing invasive aspergillosis your healthcare provider may prescribe medication to prevent aspergillosis. […] Some high-risk patients may benefit from blood tests to detect invasive aspergillosis.

• #59 Treating and Preventing Aspergillosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis/treatment

  Though it can be difficult to avoid exposure to Aspergillus, if you have severe lung disease or a weakened immune system, you should take special precautions, such as minimizing your exposure to soil and dust. […] If you are at high risk, your doctor may suggest taking antifungal drugs as a preventive measure.

• #60 Aspergillosis – Wikipedia

  https://en.wikipedia.org/wiki/Aspergillosis

  Prevention of aspergillosis involves a reduction of mold exposure via environmental infection-control. Antifungal prophylaxis can be given to high-risk patients. Posaconazole is often given as prophylaxis in severely immunocompromised patients.

• #61 Aspergillosis

  https://www.nhs.uk/conditions/aspergillosis/

  It’s almost impossible to completely avoid aspergillus mould. […] But there are things you can do to lower your chances of getting aspergillosis if you have a lung condition or weakened immune system. […] try to avoid places where aspergillus mould is often found, such as compost heaps and piles of dead leaves […] open your windows several times a day to air your rooms, especially if you’re cooking or using a shower […] wear a face mask in dusty places or when you’re gardening […] consider using a dehumidifier and an air purifier with a HEPA filter at home […] keep your house heated at between 18 and 21C in cold weather […] do not dry your laundry in your bedroom or living areas, if possible ideally dry it outside or in a tumble dryer […] do not open your windows if there’s construction work or digging outside.

• #62 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3352070/

  Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. […] Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. […] Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. […] Given the high mortality associated with invasive aspergillosis prophylaxis of invasive fungal infections would be ideal. […] Early preemptive treatment with a safe antifungal agent would be an alternative approach, if early diagnosis and effective treatment could reliably be established.

• #63 Treatment and prevention of invasive aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-and-prevention-of-invasive-aspergillosis/print

  Treatment and prevention of invasive aspergillosis […] The effective management of invasive aspergillosis includes strategies to optimize prevention, prompt diagnosis, early antifungal treatment, and, in some cases, immunomodulation and surgery. […] The epidemiology and prophylaxis of invasive fungal infections in patients with hematologic malignancies and hematopoietic cell transplant recipients are also discussed in greater detail separately. […] Optimal management involves early and definitive diagnosis as well as early initiation of antifungal therapy. In addition to antifungal therapy, surgery should be considered for patients with certain manifestations. Reduction of immunosuppression, when feasible, is another important component of management.

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